A New Procedure for Treating a Sebaceous Cyst: Removal of the Cyst

Content with a Laser Punch and the Cyst Wall with a inimal Post!oned
"#cision
HuiLing Wu,
1
ShouJie Wang,
1
LingJiao Wu,
2
and ShuSen Zheng
3
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Abstract
Sebaceous cysts are benign lesions of the skin, and cosmetic reasons for removal of cysts in an
exposed area are often mentioned. A conventional wide excision can remove the cyst completely
but with a potentially long scar. The minimal excision technique is similar to the punch
technique, which can achieve minimal scarring but carries a risk of recurrence [!"#. $or large
cysts or cysts located in areas of thick skin, the cyst wall is more friable or not easy to express,
making complete cyst removal with a better cosmetic appearance more difficult.
%ombining the advantages of two methods, we proposed a new method with two steps. $irst, a
laser is used to make a small hole for removal of the cyst content. Then the cyst wall is removed
entirely with minimal excision about month later. &e have treated ' sebaceous cysts with this
method successfully since '(().
&o to'
Surgical Techni$ue
After finding the skin conglutination located in the middle part or duct of the anterior cyst wall,
we used a carbon dioxide laser to make multiple punctures, creating a hole about '!* mm in
diameter +$ig. a, b,. -artial cystic contents were exuded through the hole by gentle pressure and
squee.ing +$ig. c,. /f the contents were solid inside, we used a small curette carefully without
damaging the wall and washed the remnants with (.01 2a%l solution to ensure that all the
contents were removed. Then we sterili.ed the inside wall of the cyst with povidine3iodine
solution. The tiny wound was closed with a single suture or held together with glue. Antibiotic
ointment was applied, and the patient was instructed to take antibiotic regularly.
$ig.
A (.43cm cyst developed during year in a *)3year3old man. a 5iew of the cyst. b A hole about
' mm in diameter created by multiple punctures of a carbon dioxide laser. c -artial cystic
contents exuded through the hole by gentle pressure ...
About month later, the cyst wall had become small. 6y using a no. 7 blade, the skin of the
formerly healed wound was incised to a length of approximately "!7 mm, and the total cyst wall
was removed easily +$ig. d,. The incision closed by natural healing in about week +$ig. e,.
&o to'
Results
The cysts included six in the face, three in the back, one in the neck, and two in other areas. 2o
complications resulted for any of these cysts. The average cyst diameter was .") cm, and the
length of the resulting scar was only about one3third the diameter of the initial cyst. $or some
small lesions on the face, the scar was inconspicuous +$igs. e and and'a, 'a, b,. Telephone
interviews were conducted for all the patients after a follow3up period of "!'* months with no
recurrence.
$ig. '
A .73cm irregular cyst in a 7"3year3old man. a 5iew of the cyst with a hole created by carbon
dioxide laser. b 5iew * days after the total cystal wall removal
&o to'
%iscussion
8ost clinicians suggest that if cyst removal is desired or indicated, every effort should be made
to remove the entire cyst lining to prevent recurrence of the sebaceous cyst [#. 6ut with excision
of a large cyst on the face, neck, or back, it is difficult to achieve an aesthetically pleasing
closure [*#. Thin3walled cysts tend to break and may need to be removed in pieces [7#, with the
risk of recurrence when the minimal excision technique is used.
The method we propose has some advantages. The laser is easy to manipulate, and the laser hole
punch results in little bleeding, giving a clear field of vision for the operating area and no
infection. After expulsion of the cyst contents, the capsule is gradually loosened and crumples to
a smaller capsule with some fluid inside. /ts complete removal is easy in the delayed operation,
which allows for dissection and excision under direct vision, providing for confident and
complete removal of the cyst wall while minimi.ing scar length. The length of the resulting scar
is only about one3third that of the initial cyst diameter, and for some small lesions on the face,
the scar is inconspicuous.
&o to'
Conclusion
The described surgical procedure produces no recurrence, with favorable cosmetic results. /t can
be a good alternative for eradication of uninfected cysts, especially large cysts or cysts located in
areas of thick skin or cosmetic concern.
&o to'
&!en Access
This article is distributed under the terms of the %reative %ommons Attribution 2oncommercial
9icense which permits any noncommercial use, distribution, and reproduction in any medium,
provided the original author+s, and source are credited.
&o to'
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